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May/June 2024

May/June 2024 Issue

Home Therapy: In-Home Therapy Going Virtual
By Keith Loria
Today’s Geriatric Medicine
Vol. 17 No. 3 P. 26

The Latest Virtual Technology for In-Home Therapy for Older Adults

There was a time when the thought of seeing a physician for home therapy was unheard of for the majority of older adults, as the oldest of them didn’t grow up with computers and video. And when technology become part of their lives, they may not have fully understood its potential or simply didn’t trust it.

But times have changed in a big way, and now most older adults prefer virtual home therapy sessions to wasting time driving to and from an appointment, and many are comfortable doing their rehab in the comfort of their own homes.

“Older adults benefit the most from virtual in-home therapy because it removes all of the stress involved in transportation, especially for those who struggle with a disability,” says Danielle Kelvas, MD, a former emergency medicine physician who now works the HCG Institute, a telehealth company, and founded DKMD Consulting. “Constantly asking family and friends for help can be really demoralizing and depressing for someone who was independent their entire life, but can no longer do what they used to.” Maybe they can’t drive anymore, or use a wheelchair; whatever the issue, having more appointments at home makes older adults feel more empowered about their health status.

“Virtual in-home therapy makes it more likely for the older population to seek medical care, so they get their questions answered, are more likely to get their medication refills on time, and seek help when they need it,” Kelvas says. “Plus, if someone struggles with dementia or a neurological disorder, leaving their home can be really disorientating. Having more of their appointments at home reduces their stress levels.” In addition, telehealth appointments also reduce patients to the exposure of other sick patients, so there’s less nosocomial transmission of illness. In addition, “It removes a lot of white coat syndrome, so older adults are more likely to schedule appointments and have their issues addressed,” Kelvas says.

Jared Gillespie, a physical therapist and senior director of clinical solutions at Academy Medtech Ventures, has more than a decade of experience as a clinician at the Baylor Scott & White Institute for Rehabilitation, the largest rehabilitation system in Texas. He’s seen that the older adult market is leading the virtual and home health revolution.

“Related to PT [physical therapy] and rehabilitative care, adequate technology in both the clinic and the home are necessary to create a virtual tether in care,” Gillespie says. “This virtual tether allows for the patient to have more autonomy over their care when they’re not in the clinic and for the clinician to connect more easily with patients to ensure informed decisions and better patient outcomes.”

Vivian Yu, a physical therapist, and founder and lead trainer of Gym Near Me, notes these systems frequently have video consultations, which are very helpful for both assessing patients and assisting them through activities.

“The objective is to make therapy accessible, engaging, and productive from the comfort of one’s own home,” she says. “Telehealth platforms, which bring the physical therapist online into the living room, are becoming increasingly popular.”

Tech Advancements
In a virtual rehabilitation scenario, technology needs to try to offset the skills that a rehab provider can provide with a live visit. For example, manual therapy provided by a clinician following a total knee replacement helps restore range of motion and decrease swelling.

“Without that intervention in a virtual setting, the technology has to step in and ensure that there is not a significant decrease in the care being provided,” Gillespie says. “This can be accomplished by advancements in computer vision technology, patient monitoring, patient education, and other technology that allows the clinician to ensure the patient is progressing as expected.”

One of the leading tech innovations that’s improved virtual in-home in recent years is the rise of artificial intelligence (AI) and machine learning. “There’s a growing emphasis on incorporating AI and machine learning into PT platforms,” Gillespie says. “These technologies facilitate personalized therapy plans based on individual patient data, enhancing

the effectiveness of treatments. They can analyze movement patterns, predict risks, and suggest modifications in real-time, offering a more tailored and responsive therapy experience.”

AI can analyze the users’ movement patterns, progress, and even their moods to tailor therapy and exercise according to it. “Since a therapy plan is a highly personal and unique thing just like a fingerprint, it constantly needs adaptation and AI can really be helpful,” Yu says.

Remote monitoring technologies have also come a long way, with remote therapeutic monitoring gaining prominence. This involves using digital tools to monitor and analyze nonphysiological data such as movement efficacy, adherence to prescribed exercises, and self-reported pain levels. Such technologies enable continuous tracking of a patient’s progress and allow for timely interventions.

“For example, if older adults struggle with Afib, any worsening symptoms can be picked up by remote patient monitoring and alert their providers, which can trigger a case management person to get them scheduled for a virtual appointment,” Kelvas says. “We can catch a lot more issues before they become large [emergency department] problems.”

Then there’s mobile technology, which includes sensors and fitness monitors. These devices track movement, balance, and even health metrics, providing therapists with real-time data to help them adapt their treatment. It’s like carrying a mini-therapist on your wrist.

Another major differentiator is virtual reality, which can build changing, immersive worlds for balance and strength training, turning therapy sessions into enjoyable games rather than boring tasks. This is excellent for motivation and engagement, particularly for the older age group.

Yu warns that it’s not a one-size-fits-all solution, however. “It is important to make these gadgets user-friendly for older people, who may not be very familiar with technology,” she says. “There’s also the human contact to keep in mind. Technology should enhance, not replace, a physical therapist’s connection and support.”

Gillespie also points to gamification of therapy as being a factor for improved virtual in-home adherence and adoption. “Integrating gamelike elements into therapy exercises to enhance engagement and motivation is a growing trend, especially among older adults,” he says.

“Gamification can make routine exercises more enjoyable and encourage regular participation, which is particularly important for older adults who may struggle with motivation.”

Wearable tech is also trending, not only the use of fitness trackers but also health monitors. Apart from steps and heart rate, they can also monitor sleep patterns and gait stability and even predict the risk of falling for older people. This data is gold for therapists, allowing them to make changes to therapy plans in real-time.

A big reason it’s so important for technology to continually advance in this space is to keep up with the growing demand. More and more orthopedic surgeries are being performed each year (roughly 18 million in 2022), which means there’s increased need for rehabilitation providers to be able to reach all of these patients. Without adequate rehabilitation, the risk for poor surgical outcomes rises, and virtual in-home therapy can play a big role in increasing access.

Improved Systems
Interactive home exercise programs (HEPs) are another draw bringing older adults to virtual in-home therapy sessions. “The standard in the market has always been a handwritten HEP that a patient follows in between their live PT sessions or in a virtual/remote environment,” Gillespie says. “Technology platforms over the past decade have evolved to include video demonstrations and progress tracking. These additions have led to improved adoption and engagement in the rehabilitation process.”

Patient-provider communication portals have also improved a great deal. For instance, direct messaging portals have opened communication lines from patients to their providers to provide a concierge service toward which society is constantly moving. This type of communication allows providers to stay up to date on patients’ progress, set-backs, or any other factors that may affect the rehab process.

“I’ve also seen firsthand the efficacy of cognitive training as it relates to rehabilitative outcomes, and research suggests that incorporating cognitive training into occupational therapy can have broad benefits for elderly patients, extending beyond cognitive improvements,” Gillespie says.

According to the findings of a 2022 study,1 compared with nonparticipants, a group of healthy older adult participants and participants who underwent cognitive training provided by occupational therapists exhibited fewer depressive symptoms and improved memory performance, visual-spatial function, fluency, and quality of life in areas such as sensory functioning, cognitive function, intimacy, and physical function.

The Pandemic Swing
Prepandemic, many older adults were apprehensive about new technology and preferred traditional in-person care delivery over virtual help. However, Gillespie says, “We’ve seen a marked shift away from this preference, so much so, in fact, that older adults are the ones leading the change here now that they’ve realized the convenience and lifestyle impact it can afford them.”

At the onset of the pandemic, Kelvas had a tough time trying to show her older patients how to sign on to a Zoom call. Now, most people are more educated on technology and how to use it.

Further, she says, “HIPAA rules were way too lax and full of cybersecurity holes at the start of the pandemic.” But now, “Tech companies have made tremendous strides in ensuring the privacy of PHI [protected health information].”

No Turning Back
A survey by McKinsey & Company reported that telehealth utilization has stabilized at levels 38 times higher than before the pandemic.2 This points to a significant and sustained adoption of virtual and in-home therapy services. It appears virtual care is here to stay and likely will evolve as further technological advances expand the possibilities and increases its reach. Kelvas looks forward to the evolution. “I’m a full supporter of telehealth and am excited to see how things develop.”

— Keith Loria is a D.C.-based award-winning journalist who has been writing for major publications for nearly 20 years on topics as diverse as real estate, travel, Broadway, and health care.


1. Cruz GP, Pereira LS, Raymundo TM. Cognitive training for elderly people without cognitive impairment: an occupational therapy intervention during the COVID-19 pandemic. Cad Bras Ter Ocup. 2022;30:e3030.

2. Bestsennyy O, Gilbert G, Harris A, Rost J. Telehealth: a quarter-trillion-dollar post-COVID-19 reality? McKinsey & Company website. Published July 9, 2021.